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Home My Public Portal About5720 OAK AVE_Plumbing_6/10/1985_c, WORKERS' COMPENSATION DECLARATION I hereby 'o Crn tha.t I have a ceslihcate of consent to self 76A667A insure, or f•- certificgte of Workers' Compensation Insurance, CE 817 (REV. 10/81) or o cvTtified copy thereof (Sec. 3000, Lab. C.) Policy No. Compamr Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspec- tion department. Dat. AppliSant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the work involved by the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so astobecome subject to the Woorrrkkkers' mpensation Laws. Dat-�/©hs— Applicant 7 • ��%i NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Number a ic. Class Contractor nate ❑lam exempt under Se, B.&P.C. for this reason nate: Signature SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Prof ssions Code): 114 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). I Lender's Nome k /• r�/�} Lender's Addr— I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the �ave -mentioned property for inspection purposes. �it.c�'c%t.r Signature of Permittee Date APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY SEE REVERSE FOR EXPLANATORY LANGUAGE Y a O V O y a Z FOR APPLICANT TO FILL IN (PRINT OR TYPE) I ADIDRESSUILDING .6 /1-Ja 019k , NUMBER FIXTURE OR ITEM Ct4 FEE LOCALITY -rL�i / Zz / c_„_ WATER CLOSET 2- Va INEAREST C� BATH TUB �7L / ICROSSST. .4jjyG✓ x r SHOWER /OrV( OWNER'MTE'1rynA/ LAVATORY MAIL 66 IADDRESS SayII(_ SINK U 6 (CITY �r TEL. NO. ��(((/d�_��I� —/ DISHWASHER 4 00 (CONTRACTOR CLOTHES WASHER O /! dADDRESS SWIMMING POOL RECEPTOR CITY TEL. NO. LAWN SPRINKLER SYSTEM . ISTATE LIC. WATER HEATER I L I Q U I LICENSE NO. L CLASS / GAS SYSTEM OUTLETS DISTRICT Nq., !) I D O /VJos/ PMRED BY PMR E OUTLETS OVER 5 PER SYSTEM FINAL DAT��g 9 VALID ON //- B QuC6� , Plan check fee 111111 2223 1 A PLUMBING PERMIT ISSUING FEE $ I �D U TOTAL FEE I n o# • . . . e 5 (•-8250 Plan check applicant Name •.. 8 2 5 0 Address 06,10-85 City Tel. No. SEE REVERSE FOR EXPLANATORY LANGUAGE Y a O V O y a Z APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK ROUGH PLUMBING GAS PIPING GAS VENT 1 HOT WATER HEATER ` PLUMBING FIXTURES / e��.Lf- GAS TEST ` 'UTILITY CO. NOTIFIED nn cc77 'FINAL •(vier on J'ronf INDUSTRIAL WASTE APPROVAL INSPECTOR'S NOTES INSPECTOR'S NOTES OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also re- quires the applicant for such permit to file a signed state- ment that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes. sions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appli- cant to a civil penalty of not more than five hundred dollars ($500).: ❑ I, as owner of the property will do the. work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Controc- for's License Low does not apply to on owner of property who builds or Improves thereon, and who does such work himself provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-bul(der will have the burden of proving that he did not build or Improve for the purpose of sale.) I am exempt under Sec , B & P.C. for this reason Dat - Owner